|
Chromosome Analysis Add Cells
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$586.96 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$548.68
|
| Rate for Payer: Aetna Managed Medicare |
$33.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.56
|
| Rate for Payer: Anthem Medicaid |
$34.58
|
| Rate for Payer: Anthem Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.47
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$586.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.02
|
| Rate for Payer: Dean Health Medicaid |
$34.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.47
|
| Rate for Payer: Health EOS Commercial |
$567.82
|
| Rate for Payer: HFN Commercial |
$586.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.47
|
| Rate for Payer: Managed Health Services Medicaid |
$35.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.47
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: NAPHCARE Commercial |
$50.20
|
| Rate for Payer: Preferred Network Access Commercial |
$586.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34.58
|
| Rate for Payer: Quartz Beloit One Network |
$312.62
|
| Rate for Payer: Quartz Commercial |
$414.70
|
| Rate for Payer: Quartz Medicare Advantage |
$33.47
|
| Rate for Payer: The Alliance Commercial |
$133.88
|
| Rate for Payer: United Healthcare Medicaid |
$34.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.47
|
| Rate for Payer: United Healthcare PPO |
$478.50
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: Wellcare Medicare |
$33.47
|
| Rate for Payer: WMAP Medicaid |
$34.58
|
| Rate for Payer: WPS Commercial |
$472.57
|
|
|
Chromosome Analysis Analyze 20
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.61 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$144.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$542.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.05
|
| Rate for Payer: Anthem Medicaid |
$149.43
|
| Rate for Payer: Anthem Medicare Advantage |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.61
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$144.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Dean Health Medicaid |
$149.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$144.61
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$149.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.61
|
| Rate for Payer: Managed Health Services Medicaid |
$155.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$144.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$144.61
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$216.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$149.43
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$144.61
|
| Rate for Payer: The Alliance Commercial |
$578.44
|
| Rate for Payer: United Healthcare Medicaid |
$149.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: United Healthcare PPO |
$1,460.25
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: Wellcare Medicare |
$144.61
|
| Rate for Payer: WMAP Medicaid |
$149.43
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
Chromosome Analysis Analyze 20
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$954.03 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,168.20
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
Chromosome Analysis Analyze 20
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,849.65 |
| Rate for Payer: Aetna Commercial |
$1,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,849.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$973.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,168.20
|
| Rate for Payer: Health EOS Commercial |
$1,771.77
|
| Rate for Payer: HFN Commercial |
$1,849.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$510.47
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,849.65
|
| Rate for Payer: Quartz Beloit One Network |
$856.68
|
| Rate for Payer: Quartz Commercial |
$1,109.79
|
| Rate for Payer: The Alliance Commercial |
$973.50
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
Chromosome Analysis, CT 15-20
|
Professional
|
Both
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,724.95 |
| Rate for Payer: Aetna Commercial |
$3,724.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.06
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,724.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,960.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,352.60
|
| Rate for Payer: Health EOS Commercial |
$3,568.11
|
| Rate for Payer: HFN Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.98
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.24
|
| Rate for Payer: Quartz Commercial |
$2,234.97
|
| Rate for Payer: The Alliance Commercial |
$1,960.50
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: WPS Commercial |
$2,904.28
|
|
|
Chromosome Analysis, CT 15-20
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$3,607.32 |
| Rate for Payer: Aetna Commercial |
$3,528.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.06
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.31
|
| Rate for Payer: Anthem Medicaid |
$129.67
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,607.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$125.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,194.19
|
| Rate for Payer: Dean Health Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$3,489.69
|
| Rate for Payer: HFN Commercial |
$3,607.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Managed Health Services Medicaid |
$134.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$125.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$188.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,607.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.29
|
| Rate for Payer: Quartz Commercial |
$2,548.65
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$501.96
|
| Rate for Payer: United Healthcare Medicaid |
$129.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare PPO |
$2,940.75
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: Wellcare Medicare |
$125.49
|
| Rate for Payer: WMAP Medicaid |
$129.67
|
| Rate for Payer: WPS Commercial |
$2,904.28
|
|
|
Chromosome Analysis, CT 15-20
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,921.29 |
| Max. Negotiated Rate |
$3,607.32 |
| Rate for Payer: Aetna Commercial |
$3,528.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.13
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,607.32
|
| Rate for Payer: Health EOS Commercial |
$3,489.69
|
| Rate for Payer: HFN Commercial |
$3,607.32
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,352.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,607.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.29
|
| Rate for Payer: Quartz Commercial |
$2,352.60
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: WPS Commercial |
$2,904.28
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$1,364.00 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Aetna Managed Medicare |
$95.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.82
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$204.60
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$221.65
|
| Rate for Payer: Quartz Medicare Advantage |
$204.60
|
| Rate for Payer: The Alliance Commercial |
$1,364.00
|
| Rate for Payer: United Healthcare PPO |
$255.75
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.09 |
| Max. Negotiated Rate |
$313.72 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$204.60
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$204.60
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
Chromosome Analysis, Interp & Report
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna Commercial |
$323.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Anthem Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$323.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.60
|
| Rate for Payer: Health EOS Commercial |
$310.31
|
| Rate for Payer: HFN Commercial |
$323.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.07
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: Preferred Network Access Commercial |
$323.95
|
| Rate for Payer: Quartz Beloit One Network |
$150.04
|
| Rate for Payer: Quartz Commercial |
$194.37
|
| Rate for Payer: The Alliance Commercial |
$170.50
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
Chromosome Analysis Karyotype
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Chromosome Analysis Karyotype
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: HFN Commercial |
$492.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.98
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Chromosome Analysis Karyotype
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$501.96 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.31
|
| Rate for Payer: Anthem Medicaid |
$129.67
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$125.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Dean Health Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Managed Health Services Medicaid |
$134.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$125.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$188.24
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.67
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$501.96
|
| Rate for Payer: United Healthcare Medicaid |
$129.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare PPO |
$388.50
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: Wellcare Medicare |
$125.49
|
| Rate for Payer: WMAP Medicaid |
$129.67
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$465.96 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$116.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.37
|
| Rate for Payer: Anthem Medicaid |
$70.04
|
| Rate for Payer: Anthem Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.49
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$116.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.94
|
| Rate for Payer: Dean Health Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$116.49
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.49
|
| Rate for Payer: Managed Health Services Medicaid |
$72.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$116.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$116.49
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$174.74
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.04
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$116.49
|
| Rate for Payer: The Alliance Commercial |
$465.96
|
| Rate for Payer: United Healthcare Medicaid |
$70.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: United Healthcare PPO |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: Wellcare Medicare |
$116.49
|
| Rate for Payer: WMAP Medicaid |
$70.04
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.88 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Aetna Commercial |
$429.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$429.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.20
|
| Rate for Payer: Health EOS Commercial |
$411.32
|
| Rate for Payer: HFN Commercial |
$429.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.21
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$429.40
|
| Rate for Payer: Quartz Beloit One Network |
$198.88
|
| Rate for Payer: Quartz Commercial |
$257.64
|
| Rate for Payer: The Alliance Commercial |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$19,665.00
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$19,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$19,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
Chronic Care Management 20 min 99490
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
4596801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.00
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: HFN Commercial |
$128.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.75
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: The Alliance Commercial |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$285.60
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.60
|
| Rate for Payer: Health EOS Commercial |
$433.16
|
| Rate for Payer: HFN Commercial |
$452.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Preferred Network Access Commercial |
$452.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.44
|
| Rate for Payer: Quartz Commercial |
$271.32
|
| Rate for Payer: The Alliance Commercial |
$238.00
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.37
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$309.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$22,892.00
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$8,234.50 |
| Max. Negotiated Rate |
$22,892.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,234.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,833.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,668.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,986.30
|
| Rate for Payer: Anthem Medicare Advantage |
$8,234.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,234.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,234.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,234.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,415.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,234.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,555.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,234.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,234.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,234.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,234.50
|
| Rate for Payer: NAPHCARE Commercial |
$12,351.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,234.50
|
| Rate for Payer: The Alliance Commercial |
$22,892.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,234.50
|
| Rate for Payer: United Healthcare PPO |
$12,888.67
|
| Rate for Payer: Wellcare Medicare |
$8,234.50
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$29,618.00
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$10,654.01 |
| Max. Negotiated Rate |
$29,618.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,654.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,078.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,689.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,805.80
|
| Rate for Payer: Anthem Medicare Advantage |
$10,654.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,654.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,654.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,654.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,655.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,654.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,489.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,654.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,654.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,654.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,654.01
|
| Rate for Payer: NAPHCARE Commercial |
$15,981.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.01
|
| Rate for Payer: The Alliance Commercial |
$29,618.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,654.01
|
| Rate for Payer: United Healthcare PPO |
$16,729.46
|
| Rate for Payer: Wellcare Medicare |
$10,654.01
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,383.00
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$6,252.99 |
| Max. Negotiated Rate |
$17,383.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,252.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,427.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,291.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,777.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6,252.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,252.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,252.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,252.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,854.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,252.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,515.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,252.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,252.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,252.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,252.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,379.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6,252.99
|
| Rate for Payer: The Alliance Commercial |
$17,383.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,252.99
|
| Rate for Payer: United Healthcare PPO |
$9,743.17
|
| Rate for Payer: Wellcare Medicare |
$6,252.99
|
|
|
CHRONOS PHOSPHATE GRANULES 710.019.97S
|
Facility
|
OP
|
$6,765.00
|
|
| Hospital Charge Code |
2966161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,894.20 |
| Max. Negotiated Rate |
$27,060.00 |
| Rate for Payer: Aetna Commercial |
$6,088.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,817.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,894.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,397.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,382.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,247.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,585.45
|
| Rate for Payer: Cash Price |
$2,029.50
|
| Rate for Payer: Cigna Commercial |
$6,223.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,785.69
|
| Rate for Payer: Health EOS Commercial |
$6,020.85
|
| Rate for Payer: HFN Commercial |
$6,223.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,073.75
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,059.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,223.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,314.85
|
| Rate for Payer: Quartz Commercial |
$4,397.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,059.00
|
| Rate for Payer: The Alliance Commercial |
$27,060.00
|
| Rate for Payer: WEA Trust Commercial |
$3,720.75
|
| Rate for Payer: WPS Commercial |
$5,010.84
|
|
